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Letters to the Editor

Response to John M. Poothullil

Human Nutrition Unit University of Sydney Sydney, NSW 2006 s.dickinson{at}mmb.usyd.edu.au

Dear Editor,

We thank Dr. Poothullil for his comments on our recent publication (1 ), which showed marked postprandial hyperglycemia and hyperinsulinemia after a carbohydrate challenge in lean, young adults of South East (SE) Asian origin compared with that of matched Caucasian subjects. Dr. Poothullil hypothesizes that programming of genetic factors under the influence of intrauterine nutritional status may predispose certain individuals/ethnic groups to having insufficient fat storage capacity to accommodate the postprandial flux in blood glucose. Although this is an interesting point, a recent follow-up study of ours (unpublished data) involving 20 SE Asian (Thai, Vietnamese) and 20 European Caucasian subjects does not support this idea. In the study, we used dual energy X-ray absorptiometry (DEXA) to determine total body fat, and ¹H nuclear magnetic resonance (NMR) imaging/spectroscopy (MRI/MRS) to measure levels of intra-abdominal visceral and intramyocellular fat (IMCL). Both visceral fat and IMCL levels have been shown be positively correlated with the degree of insulin resistance (2 –4 ). Despite comparable body mass index and waist circumference, the SE Asian group had significantly higher body fat (P = 0.04), visceral fat (P = 0.02) and IMCL (P < 0.01) than the Caucasians. Insulin resistance as determined by the homeostasis modeling assessment was also higher in the SE Asian group. More importantly, we found no correlation between visceral fat, IMCL and the degree of postprandial glycemia or insulin resistance. Furthermore, there is no evidence to suggest that our SE Asian subjects had reached their maximum fat storage capacity. In fact, increased fat deposition occurs with age (5 –7 ). It therefore seems unlikely that the SE Asian group in our published study lacked sufficient adipose tissue stores to accommodate postprandial glycemia. It would be more logical for programming in utero to produce higher, not lower fat storage capacity.

Manuscript received 12 November 2002. Revision accepted 13 November 2002.

LITERATURE CITED

1. Dickinson, S., Colagiuri, S., Faramus, E., Petocz, P. & Brand-Miller, J. C. (2002) Postprandial hyperglycemia and insulin sensitivity differ among lean young adults of different ethnicities. J. Nutr. 132:2574-2579.[Abstract/Free Full Text]

2. Yamashita, S., Nakamura, T., Shimomura, I., Nishida, M., Yoshida, S., Kotani, K., Kameda-Takemuara, K., Tokunaga, K. & Matsuzawa, Y. (1996) Insulin resistance and body fat distribution. Diabetes Care 19:287-291.[Abstract]

3. Kobayashi, H., Nakamura, T., Miyaoka, K., Nishida, M., Funahashi, T., Yamashita, S. & Matsuzawa, Y. (2001) Visceral fat accumulation contributes to insulin resistance, small-sized low-density lipoprotein, and progression of coronary artery disease in middle-aged non-obese Japanese men. Jpn. Circ. J. 65:193-199.[Medline]

4. Krssak, M., Falk, P. K., Dresner, A., Di, P. L., Vogel, S., Rothman, D., Roden, M. & Shulman, G. (1999) Intramyocellular lipid concentrations are correlated with insulin sensitivity in humans: a ¹H NMR spectroscopy study. Diabetologia 42:113-116.[Medline]

5. Gould, A. J., Williams, D. E., Byrne, C. D., Hales, C. N. & Wareham, N. J. (1999) Prospective cohort study of the relationship of markers of insulin resistance and secretion with weight gain and changes in regional adiposity. Int. J. Obes. Relat. Metab. Disord. 23:1256-1261.[Medline]

6. Johnson, M. S., Figueroa-Colon, R., Huang, T. T., Dwyer, J. H. & Goran, M. I. (2001) Longitudinal changes in body fat in African American and Caucasian children: influence of fasting insulin and insulin sensitivity. J. Clin. Endocrinol. Metab. 86:3182-3187.[Abstract/Free Full Text]

7. Sigal, R. J., El-Hashimy, M., Martin, B. C., Soeldner, J. S., Krolewski, A. S. & Warram, J. H. (1997) Acute postchallenge hyperinsulinemia predicts weight gain: a prospective study. Diabetes 46:1025-1029.[Abstract]

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